Dsm Expansion

To me, the expansion of the DSM is the most important topic in the field of psychology today. The Diagnostic and Statistical Manual of Mental Disorders is used by not only psychologists, but also psychiatrists, clinicians, drug agencies, pharmaceutical companies, researchers, health insurance companies, and even entities such as government policy makers and the legal system. This manual establishes a common language for these vastly different fields by giving a standard set of criteria to allow them to classify and categorize mental disorders. With such a broad reach, it is imperative this language and the criteria sets in this manual are chosen extremely cautiously and carefully as they clearly seep into almost every part of peoples life’s in one way or another. Certainly if any carelessness or ulterior motives are used in the process of writing this manual, lasting damaging effects are inevitable. It would be impossible to delve into every intricate piece of this issue and explain how the change of criteria or wording for every disorder can snowball into problems. I will only summarize some of the key issues surrounding the controversy of the latest DSM-5 expansion and in doing so highlight some disorders changes and their effects. The point will be to demonstrate how if even these small rippling changes affect so many that plainly a whole wave of affects ensues when we continue to add them to the manual.

First, it is important to note who is in charge of creating these manuals in the first place. The American Psychiatric Association (APA) published the diagnostic handbook in 2013. (Pickergill 1) The DSM-5 follows a line of manuals that have only expanded in length since the first one and all were published by the APA. Therefore it is psychiatrists who are in charge of determining all the contents of the manual. It is important to note the differences in psychiatrists and psychologists in that psychiatrists write prescriptions for medications whereas psychologists do not. This already in my opinion raises a red flag. Not all psychiatrists are influenced by drug companies and cannot all be put in the same category just as all psychologists practice the same school of therapy, however it is critical to look at the particular psychiatrists that were on the task force for the DSM-5. It is the difference between those who write prescriptions and those who do not that come in to play here because of what could influence the recommendations these particular task force members make.

Lisa Cosgrove, PhD in an article for the Psychiatric Times entitled Toward Credible Conflict of Interest Policies in Clinical Psychiatry states a pretty alarming fact about those members of the DSM-5 task force. She states that of the 27 members, only 8 reported no industry relationships (she is referring to pharmaceutical company ties). This means that 70% of the members disclose ties to the drug industry and that number increased by 14% from the force for the DSM-IV according to Cosgrove. My thoughts are that it is impossible and unavoidable for these members to not be influenced in some way no matter how unbiased they give an oath to be or maybe even believe themselves they are being. It is hard to find a human on this planet that acts solely and completely without their own gain or advantage in mind. The very people who are deciding what should or should not be included in this manual stand to gain by its expansion because with more disorders come more potential clients so there is the incentive for the psychiatrist. More patients means medication and there is the incentive for the drug company. The pharmaceutical industry clearly as a result has much to gain financially from more disorders being included and therefore if tied to psychiatrists would influence any changes that further these gains. It may seem like their influence on just simple guideline development shouldn’t be a concern, but guidelines are what are used by psychologists and psychiatrists to diagnose patients, and these diagnoses inform the treatment decisions. Therefore, the industry has a huge vested interest in how the DSM is structured, in its content, and in its symptomatology (Cosgrove). Using just one profession of people to determine what the qualifications are for current mental disorders and the power and authority to define new ones just isn’t sufficient in my opinion. It gives too much power to one school of thinking and in reading some history of the psychiatry itself gives me even more pause in the process that is set in place to define mental illness. Leon Eisenberg a professor at Harvard Medical School made a statement that sums up the shift psychiatry before the 1950’s to where we are today by saying that the field “moved from a state of brainlessness to one of mindlessness”. He is referring to the interest people took in the brain and neurotransmitters after psychoactive drugs were introducing in the fifties. As psychiatrists lost interest in the stories of their patients and more into their brain function and the ability to alter it, they shifted from the popular Fruedian model of the time to a biological one. The goal became using drugs to eliminate symptoms. A pull back occurred in the 1970’s due to the obvious negative side effects of drugs on people. It left a big question about whether they were doing more harm than good (Angell,).